Toxicology Observations

Foxy Methoxy: A New Drug Of Abuse

Susan C. Smolinske, PharmD, DABAT a, Rahul Rastogi, MD b, Stephen Schenkel, MD, MPP c

a Children’s Hospital of Michigan Regional Poison Control Center, Detroit, MI b St. Joseph Mercy Hospital, Ann Arbor, MI c University of Michigan, Ann Arbor, MI

REPRINTED FROM THE INT J MED TOXICOL 2004; 7(1): 3.

ABSTRACT

Introduction: In 1999, a new synthetic , 5-MeO-DIPT, became known as a street drug, with the street name of “Foxy” or “Foxy Methoxy”. By February 2003, the DEA reported law enforcement seizures and/or reports of abuse in 12 states. We report a case along with an analysis of poison center data on this new drug of abuse. Case report: A 19-year-old male was brought to the emergency department following ingestion of a larger than his usual dose of Foxy. Upon arrival, he had hallucinations, hypertension, tachycardia, mydriasis, and catalepsy. Symptoms resolved within two hours after administration of lorazepam and he recovered uneventfully. Discussion: The AAPCC TESS database contained 41 exposures to “Foxy” between April, 2002 and June, 2003; 26 had moderate or major effects, indicating this drug has significant toxic potential. Given the expanding use of this and other club drugs, the spec- trum of toxicity from this new agent will continue to be elucidated.

INTRODUCTION instead he was staring into space with his eyes open and repeat- ing “yeah . . .” in response to any stimulation. His girlfriend In 1999, a new synthetic tryptamine, 5-methoxy-N, N- revealed that he had taken some “Foxy”—a white powder diisopropyltryptamine (5-MeO-DIPT), became known as a street purchased from an Internet source for $75/gram at 9 P.M. the drug, with the street name of “Foxy” or “Foxy Methoxy.” By prior evening. Seeking a stronger high, he had taken more than February, 2003, the DEA reported law enforcement seizures ever before, but she was unable to provide the exact quantity. He and/or reports of abuse in 12 states [1]. We report a case with an had no past medical history, took no regular medications, and unusual neurological presentation. had no allergies to medications. She did not believe there was any additional drug use. CASE REPORT On examination he had a pulse of 138/min, respiratory rate of 15/min, blood pressure of 191/102 mm Hg, and an oxygen A 19-year-old male with multiple body piercing was brought to saturation of 100%. His pupils were dilated at 7 mm and respon- the emergency department at 7 A.M. by his girlfriend. On initial sive, his skin cool and dry. Lungs were clear, heart sounds regular examination he was entirely unable to answer any questions, and hyperdynamic, and abdomen soft with occasional bowel

Note: Presented in part as The 2003 North American Congress of Clinical Toxicology Annual meeting, September 4–9, 2003, Chicago, Illinois.

Keywords: tryptamine, , , catalepsy, poisoning Corresponding Author: Susan C. Smolinske, PharmD, DABAT, Children’s Hospital of Michigan Regional Poison Control Center, 4160 John R, Suite 616, Detroit, MI 48201. Email: [email protected]

JOURNAL OF MEDICAL TOXICOLOGY ■ VOLUME 1, NUMBER 1 ■ DECEMBER 2005 23 sounds. He continued to reply “yeah . . .” throughout the exam- they noted “What remains with me the longest was the aware- ination. His extremities demonstrated a waxy plasticity; remain- ness of vibrations, and what felt best was the stillness” [5]. A ing in whatever position the examiner placed them. 10 mg dose, though, did not necessarily lead to a pleasant expe- Laboratory studies demonstrated an elevated white blood rience: “As I became more turned on the greater I felt the sense cell count with a left shift and slightly elevated platelet count. of hypertension. A mind/body load became uncomfortable. It His sodium was 138 mEq/L, potassium 3.6 mEq/L, bicarbonate was never psychedelic in the way of acid or . My mus- 23 mg/dL, and glucose 275 mg/dL. Serum blood urea nitrogen cles, gluteus maximus, the lateral rotators that connect to the and creatinine were unremarkable. Calcium was 9.6 mg/dL trochanter and the large muscles that connect to the hamstrings, and myoglobin 19.2 mcg/L. An ECG showed sinus tachycardia. all contracted and spasmed.” Urinalysis demonstrated 3ϩ glucose and was otherwise unre- There is little guidance as to the side effects or toxic effects of markable. His urine drug screen was positive for and 5-MeO-DIPT. The general side effects of the tryptamine class par- . tially explain the symptoms of our case patient, specifically his Treatment was symptomatic and supportive. As he was hallucinations, mydriasis, hypertension, and tachycardia. A 17- maintaining his airway, no airway intervention was indicated. year-old patient who ingested a related compound purchased over An intravenous line was placed, as was a Foley catheter. He re- the Internet, -methyltryptamine, exhibited bizarre behavior, ceived normal saline. He was given 1 mg lorazepam twice for his tachycardia, diaphoresis, and mydriasis, with an onset of 15 tachycardia and hypertension. Over the next several hours the minutes after ingestion [6]. A 21-year-old patient who ingested a tachycardia and hypertension resolved, and the patient became “Foxy” pill purchased on the street and confirmed with urine GC- more responsive. The patient then denied the use of cocaine and MS developed visual hallucinations, mydriasis, and temporary explained that he had never taken so much “Foxy.” By noon he paralysis of his extremities lasting 3.5 hours. Notable is this case was appropriate and comfortable, his heart rate and blood pres- and in our patient, the urine immunoassay was negative for am- sure normalized, and he was discharged home from the emer- phetamines [7]. gency department. Urine assay for was not available The patient’s soft pliability was the most remarkable feature at this hospital. of his presentation, yet is not a finding typical of the trypta- mines. Such a presentation suggests effects of other intoxicants DISCUSSION including LSD, lithium, monoamine oxidase inhibitors, or side effects such as neuroleptic malignant syndrome or serotonin Foxy or Foxy Methoxy is 5-methoxy-N, N-diisopropyltryptamine, syndrome. Rigidity has been described as an effect of phencycli- a synthetic tryptamine in the same class as psilocybin or . dine; our patient, however, was distinctly more waxy and plas- Law enforcement agencies report seizures of capsules and tablets tic than rigid [8]. Our patient had no temperature recorded to in ten states since 2001. Its’ use has been reported at clubs in Ari- suggest whether there was associated hyperthermia. The positive zona, California, Florida, Delaware, Idaho, and New York, and, urine drug screen for phencyclidine may represent a class-based as this case suggests, is likely more widely distributed [1]. Foxy is cross-reaction from 5-MeO-DIPT, although there are no data re- usually administered in tablet form, often described with an garding cross-reaction with tryptamines. It is also possible the alien or spider logo, but powder-filled capsules have been confis- patient co-ingested , which is a common cated. This case and one other reported to TESS involved pow- cross-reactant in this geographic area, or that the purchased dered form. The powder and ingredients for manufacture appear product contained cocaine and/or PCP as an adulterant. The still to be available on the Internet, as are instructions regarding combined effects of 5-MeO-DIPT and dextromethorphan could its dosing and usage [2]. As in this case, users develop tolerance result in serotonin syndrome, as the tryptamines are serotonin and often escalate the dose to achieve a greater effect. An emer- agonists. Unfortunately, a confirmatory assay was not available. gency scheduling into Schedule I took place on February 28, The pharmacology and receptor affinities of 5-MeO-DIPT have 2003, [3] however the chemical is still listed as available “for sci- not been studied. Catalepsy has been speculated to occur from entific purposes” on at least one web site [2]. 5HT2 agonists, as a result of associated decreased cortical The most detailed descriptions of the effects of the drug levels. are those of its developers who synthesized it along with other The positive cocaine screen is somewhat more difficult to tryptamines [4]. They found a threshold for hallucinogenic explain. The patient later denied any recent use of cocaine, but activity at 4 mg with an effective range from 6–10 mg. Time of the sympathomimetic effects of the drug would also explain his onset was 20–30 minutes and peak effect at 1–1.5 hours, with tachycardia and hypertension. The combined use might also resolution of symptoms by approximately six hours. In their ini- exacerbate the muscular plasticity due to serotinergic effects of tial report, Shulgin and Carter felt that the drugs were relatively cocaine. It is conceivable that our patient did not know about free of autonomic side-effects or any indicators of toxicity be- cocaine lacing his 5-MeO-DIPT powder, but more likely he de- yond mild nausea and muscular hyperreflexia. nied use of illicit substances to avoid arrest. He maintained that Shulgin and Shulgin also described the use of the drugs in 5-MeO-DIPT was legal and a research chemical. We cannot fully more poetic tones in a book published on the Internet. At six mg explain the patient’s glucosuria and hyperglycemia. He was not

24 JOURNAL OF MEDICAL TOXICOLOGY ■ VOLUME 1, NUMBER 1 ■ DECEMBER 2005 Figure 1. Cumulative cases of 5 methoxy di isopropyl tryptamine (abuse, suicide) by month, by state, April 2002–June 2003. Acknowledgement: Map created by Amy B. Funk, U.S. Centers for Disease Control. diabetic. He received no glucose containing fluids. This could Acknowledgment have arisen from his stress reaction and hyperdynamic state. We are grateful to William Watson, PharmD and the American The American Association of Poison Control Centers TESS Association of Poison Control Centers for analysis of the TESS database was searched, and contained 41 cases of 5-MeO-DIPT database. exposure reports to poison centers from April 2002, which was the earliest year the term could be searched, to the end of June 2003. The outcome of these exposures was no effect in one REFERENCES case, minor in 8, moderate in 26, and major in two. Clinical effects commonly involved agitation (59%), hallucinations 1. DEA Intelligence Division. Trippin? on Tryptamines: The (39%), tachycardia (37%), hypertension (17%), and confusion Emergence of Foxy and AMT as Drugs of Abuse. Microgram (15%). Tremors (5%) and seizures (1 case) were rare. Traclomg Bulletin 2002;35:264–268. of cumulative cases indicates a relatively constant low rate of 2. Direct NIC [homepage on the Internet], [under construc- reporting, indicative of a limited number of suppliers. tion; cited 1/5/04]. Available from: http://www.edtchemical However, the geographic area of TESS cases has expanded .com/5-MeO-DIPT.htm. (Figure 1). Only three states were involved from April 2002 to July 3. Drug Enforcement Administration. Schedules of 2002, then seven by the end of October, then 12 by December Controlled Substances:Temporary Placement of Alpha- 2002, with our case representing one of two new states reporting a methyltryptamine and 5-methoxy-N,N-diisopropyltryptamine case in the first two months of 2003, ending in 17 states by June Into Schedule I. Federal Register 2003:68:4127–4130. 2003. In addition, there were two states where information calls 4. Shulgin AT, Carter MF. N,N-Diisopropyltryptamine (DIPT) about 5-MeO-DIPT were received by a poison center, but no hu- and 5-Methoxy-N,N-Diisopropyltryptamine (5-MeO-DIPT. Two man exposures reported. Such plots could be monitored prospec- Orally Active Tryptamine Analogs with CNS Activity. Commu- tively and in real-time, providing an early warning should abuse nications in Psychopharmacology 1980; 4:363–369. begin to increase. Often scheduling a drug as a controlled sub- 5. Shulgin A, Shulgin A. PIHKAL: A Chemical Love Story. stance has the effect of stimulating desire for abuse, and this could Berkeley: Transform Press; 1991. easily be demonstrated through TESS monitoring. Other surveil- 6. Long H, Nelson LS, Hoffman RS. Alpha-methyltryptamine: lance systems, such as DAWN, are less currently updated, with the Revisited via easy internet access. Vet Human Toxicol latest reports only for the year 2001, and no mention of “Foxy.” 2003;45:149. We believe that this is the first case of catalepsy described 7. Meatherall R, Sharma P. Foxy, a designer tryptamine with this agent, with one previous report of limb “paralysis” [7]. hallucinogen. J Anal Toxicol 2003; 27:313–317. The duration of more than 5 hours was longer than that previ- 8. Olson KR. Phencyclidine. In: Olson KR, editor. Poisoning ously reported, possibly due to the large dose or interaction with and drug overdose. 3rd ed. Stamford: Appleton & Lange; 1999. possible co-ingestants. Given the expanding use of this and p. 254–255. other club drugs, the spectrum of toxicity from this new agent will continue to be elucidated.

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